极早早产儿支气管肺发育不良严重程度危险因素分析

RISK FACTORS FOR SEVERITY OF BRONCHOPULMONARY DYSPLASIA IN VERY PRETERM INFANTS

目的探讨影响极早早产儿支气管肺发育不良（BPD）严重程度的危险因素。方法回顾性分析2012年1月—2015年8月我科收治的胎龄≤29周且存活28d以上的BPD早产儿74例,根据临床分度标准分为轻度BPD组（34例）、中度BPD组（30例）和重度BPD组（10例）。对各组出生情况、母亲孕期情况、病儿治疗情况进行比较,对单因素分析中有意义的因素进行多因素Logistic回归分析。结果 3组病儿胎龄、出生体质量、母亲孕期感染、合并肺炎、采用InSure模式、机械通气及时间、血培养阳性等比较差异有统计学意义（F=46.424~86.898,χ2=6.554~12.583,P〈0.05）。Logistic回归分析结果显示,合并肺炎（OR=5.882,P〈0.05）、机械通气时间长（OR=1.468,P〈0.05）是BPD严重程度的独立危险因素,采用InSure模式（OR=0.642,P〈0.05）为保护因素。结论较小胎龄及较低出生体质量、机械通气应用、肺部感染与重症BPD密切相关。加强较小胎龄及较低出生体质量早产儿管理、经鼻持续气道正压通气应用、减少机械通气应用及缩短机械通气时间、防治肺部感染是预防极早早产儿重症BPD的重要措施。

Objective To explore the risk factors for severity of bronchopulmonary dysplasia（BPD）in very preterm infants（VPIs）. Methods A retrospective analysis was done in 74 cases of VPIs,fetal age ≤29weeks,survived more than 28 days,treated in our department-during the period from January 2012 to August 2015.According to the standard of BPD,they were divided into three groups as：mild group（n=34）,moderate group（n=30）and severe group（n=10）.Birth condition,maternal condition during pregnancy,and sick infant＇s treatment were compared among the three groups.Significant factors noted in the single factor analysis were taken for logistic regression analysis. Results The differences in gestational age,birth weight,maternal perinatal infection,pneumonia,use of the InSure,mechanical ventilation and duration,and positive blood culture among the three groups were statistically significant（F=46.424-86.898,χ2=6.554-12.583,P〈0.05）.Logistic regression analysis indicated that complicating pneumonia（OR=5.882,P〈0.05）and long-time mechanical ventilation（OR=1.468,P〈0.05）were independent risk factors for BPD,but applying the InSure technique was a protection factor（OR=0.642,P〈0.05）. Conclusion Small gestation age,low birth weight,use of mechanical ventilation and pulmonary infection are closely associated with severe bronchopulmonary dysplasia.Strengthening the management of small-gestation-age and low birth-weight premature infants,using NCPAP,reducing mechanical ventilation,shortening mechanical ventilation time,preventing and treating pulmonary infection are important measures for prevention of severe bronchopulmonary dysplasia in very preterm infants.